Relieving Stress and Anxiety During COVID-19

Tips on mental health resilience from medical professionals

As weeks turn into months for millions of people around the globe who are social distancing, the COVID-19 pandemic is taking a toll on more than physical health. A recent poll by the Kaiser Family Foundation found that 45% of adults say the pandemic has affected their mental health.

An estimated 2.6 billion people, about one-third of the world’s population, are under some form of lockdown, making this “arguably the largest psychological experiment ever,” according to Dr. Elke Van Hoof, a professor of psychology at Vrije Universiteit Brussel.

The current lockdowns are causing a variety of stresses and challenges. Some households may have essential workers and frontline medical personnel who worry about not isolating, potentially exposing themselves and their families to the virus. In some cases, both parents are working at home while also supervising their children’s schooling. Those who live alone may be struggling with loneliness and isolation.

Humans are social beings. Working and living in groups have given the human race the greatest chance of survival against threats. We now live in a world where we must physically distance ourselves from others in order to stay safe—a scenario the brain and the immune system aren’t designed for long term.

Isolation can cause an increase in the stress response, which can be beneficial in the short term so long as it returns to a “baseline” level. However, if the stress response becomes chronic, it can increase inflammation in the body and decrease anti-viral activity, making us more likely to feel fatigued and even become more susceptible to viruses. The prolonged stress of isolation can also cause mental health issues such as sleep problems, anxiety, depression, and edginess.

For nearly all of us, this forced isolation is a first. But history can give us some perspective on how social distancing and long-term worry during a pandemic may affect mental health. Norwegian researcher Svenn-Erik Mamelund, PhD, studied the mental health effects of the 1918–1919 Spanish flu pandemic, the last time the world saw widespread infection and social isolation. Dr. Mamelund looked at asylum hospitalizations in Norway from 1872 to 1929 and found that the number of first-time hospitalizations for mental disorders attributed to influenza increased by an average annual factor of 7.2 in the six years following the pandemic. He also found that Spanish Flu survivors reported sleep disturbances, depression, mental distraction, dizziness, and difficulties coping at work.

In the 1990s France led the way in revolutionizing the international community’s response to disasters. Through studying the psychological effects of catastrophic events like terrorist attacks, the French advocated setting up triage posts for psychological problems, in addition to medical field hospitals.

 Dr. Van Hoof says, “In New York, we see literal field hospitals in the middle of Central Park . . . [but] we’re not setting up the second tent for psychological help.” She believes if we don’t address the need for psychological support, we will pay the price when the lockdowns have ended.

One advantage we have in today’s pandemic is the ability to stay socially connected through technology. However, that same technology could be adding to stress levels. The Institute for Functional Medicine (IFM) says that spending too much time following the news or researching the coronavirus can negatively impact our sense of well-being and compromise our physical health. Reports often contain words like outbreak, pandemic, and quarantine which can stir up a lot of anxiety, and even panic. While it can be tempting to stay on top of all the pandemic news, the IFM reminds us that experts are still learning about COVID-19. To reduce stress and anxiety, take a deep breath and step back from the news, the IFM advises. 

Psychologists stress the importance of maintaining a strong sense of social connection and belonging in order to manage the stresses of isolation. George Slavich, the founding director of the UCLA Laboratory for Stress Assessment and Research, suggests we reconsider using the term “social distancing” and instead talk about “physical distancing with distant socializing.” He points out that there are many things we cannot control during this pandemic, but we can make the best of a bad situation by focusing on the things we are able to control and recognizing that we are all in this experience together.

Sleep is an often-overlooked anchor to maintaining both physical and mental health during an uncertain time. A recent study monitored the sleep of participants for a week, then exposed them to a virus. Those who slept an average of six hours or less were four times more likely to get sick than those who slept seven hours or more. Sleep has a significant effect on immune function, yet the disruption in routines for people who are now on lockdown has caused sleep problems. Dr. Catherine Darley, ND, told Integrative Practitioner that if you need to wake with an alarm, it’s a signal you probably are not getting adequate sleep. She expressed concern that alcohol sales increased 300–500% in many areas in the early weeks of the government lockdown. She advises avoiding alcohol as it interferes with our ability to get a good night’s sleep. Although space may be at a premium at home right now, Dr. Darley recommends being mindful of having separate places for sleep and wakeful activities, reserving the bed for sleep only.

Parents have the added challenge of worrying about their children’s mental health during this stressful time. Children have lost the structure and social connections found in school. Many are trying to learn in a household with elevated stress levels where the routines they once relied on have disappeared. Dr. Jack Shonkoff, the director of the Center on the Developing Child at Harvard University, says “Social distancing is exactly what we don’t want” when it comes to the brain development of children. “If we separate physically and don’t find a way to stay connected, then we are creating an environment that is undermining the healthy development in young children.”

Dr. Shonkoff stresses that parents need to allow themselves some time to pay attention to their own needs so they are better able to create the best environment for learning and healthy development for their children. “In this particular crisis we are in right now, meeting the needs for the adults who care for the children is the only way to meet the needs of the children. You cannot bypass the needs of the adults.”

Managing stress and building resiliency during this time of pandemic may take some practice, but taking time each day to practice stress management techniques can have potentially powerful effects on your immune system and improve well-being. Below are some tips for mental health resilience that you can put into practice:

STAY SOCIALLY CONNECTED:

• Connect with friends and family remotely. Take time to send messages and make phone calls to loved ones who aren’t in lockdown with you. Set up regular group video calls with extended family or social circles, and do the same for children and their friends. Technology can be a source of support, connection, and education.
• Unsubscribe from social media sites that negatively impact your mood and turn off notifications on coronavirus-related content.
• Create social events online around topics you’re interested in—maybe it’s sharing recipes, a virtual book club, or even exercising or doing yoga together.
• Reach out to colleagues. This is just as important as reaching out to friends and family—your colleagues may be able to share some of your worries that others cannot relate to.
• Be of service. Check in on people in your community who may be in need and help if you are able. Writing letters to seniors in nursing homes is one way to be of service without leaving your home.

TAKE CARE OF YOURSELF:

• Prioritize sleep. Try to get outside within the first few hours of waking for some full spectrum light exposure to help maintain circadian rhythm. At night, wind down by minimizing screen time and dimming lights before bed, and try to sleep in total darkness.
• Get outside. Spending time outside each day, regardless of weather, helps manage stress, reduce anxiety and being in nature is scientifically proven to boost your immune system.
• Stick to a routine. Getting up, eating meals, exercising, and going to bed at the same time each day can help improve sleep and provide some comforting normalcy while at home.
• Take multiple breaks. Walk outside or to another area of the house where you can get a change of scenery, get some movement, and take a few deep, calming breaths.
• Eat nutritious food. Resist the urge to “stress eat” and instead choose healthful foods that will help boost your immunity and improve well-being.
• Exercise. Physical activity reduces stress and increases expression of feel-good neurotransmitters while also boosting immunity. Exercise doesn’t have to mean an intense workout—it can be “bite-sized” amounts of movement throughout the day.
• Listen to music. Music can soothe, inspire, improve mood, and help you focus.

LOOK INWARD:

• Try meditating. Meditation improves mental clarity, emotional tranquility, and physical relaxation. With practice, meditation can teach us to be joyful in any situation. Find a time each day to spend a few minutes to meditate. Doing this at the beginning of the day can set you up for a calmer day. There are many free apps for meditation that can help you get started.
• Start journaling. Getting your feelings down on paper can allow you to set stressful thoughts aside.
• Let yourself grieve the loss of your normal routine. Being out of your social or professional network, even if temporary, can raise feelings of sadness.
• Practice acceptance. When frustrations arise over things you cannot change, trying telling yourself “it just is” as you adjust to the new reality.
• Practice gratitude. Focusing on the positive elements of your life can improve mood and, if shared, may have a ripple effect in increased positivity on those around you.
• Take the time to reflect on your life, your goals, and your relationships. It may be a good time to decide how you want your life to look after the lockdowns are over.
• Adjust expectations. You do NOT have to learn a new language or write the next bestseller during this time. Allow yourself to be realistic and flexible, and realize you are doing the best you can right now.

TAKE TIME TO ENJOY LIFE:

• Catch up on your reading. Reading for pleasure can be a good escape and take your mind off stress.
• Start a garden, even if it’s just an herb garden. The combination of growing your own food and being in nature can be soothing and even improve cognitive function.
• Strive for a harmonious home. Talk with immediate family members, especially children, to allow them to verbalize their feelings. Offering to listen to loved ones’ feelings can help relieve household stress.
• Find opportunities to play—it’s not just for children. Play allows us to be engaged and feel a sense of mastery. Try board games, karaoke, a dance party, or let children make up a game for everyone to enjoy together.
• Celebrate good habits. Whenever you are able to practice any of these positive habits, take a moment to recognize and honor yourself; revel in the positivity.
• Taking the time to reduce stress while physically distancing is an important way to nurture your mental well-being and improve resilience. If you have been using the tips above and are still struggling, do not wait until the lockdowns are lifted before getting additional help. Many resources are available to help without leaving your home.

Helpful Resources:

If you or someone you know begins to exhibit depressive symptoms or has thoughts of suicide, please call the National Suicide Prevention Lifeline (https://suicidepreventionlifeline.org) at 800-273-8255. Crisis counselors are available 24/7 to provide free and confidential support to those experiencing emotional distress or crisis.

National Alliance on Mental Illness (NAMI) Helpline at 800-950-6264 M-F, 10 am – 6 pm, ET Or in a crisis, text "NAMI" to 741741 for 24/7, confidential, free crisis counseling.

Many communities and organizations offer support and services such as crisis hotlines, food delivery, and relief funds. In the U.S. and Canada, call 211 or visit http://211.org/services/covid19.

Amen Clinics offers mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. 888-568-6141

Meditation apps:

Calm https://www.calm.com/

The Chopra Center apps https://chopra.com/apps

Headspace http://www.headspace.com/

Ten Percent Happier http://www.tenpercent.com

Insight Timer http://www.insighttimer.com